Provider Demographics
NPI:1225645500
Name:THOMAS, TAMMY LYNEA
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14076 BAYMONT DR NE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:44669-9657
Mailing Address - Country:US
Mailing Address - Phone:440-645-7956
Mailing Address - Fax:
Practice Address - Street 1:14076 BAYMONT DR NE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:OH
Practice Address - Zip Code:44669-9657
Practice Address - Country:US
Practice Address - Phone:440-645-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7611012Medicaid